Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
A rigid proctosigmoidoscopy is a diagnostic and therapeutic procedure that involves the examination of the rectum and the lower part of the sigmoid colon using a rigid scope. This procedure is specifically performed to address a condition known as volvulus, which is characterized by the twisting of the intestines, leading to an obstruction. The procedure begins with the insertion of an obturator into the proctosigmoidoscope, which is then introduced into the anus and advanced approximately 5 centimeters into the rectum. Once the scope is in position, the obturator is removed, and an eyepiece is attached to allow for visualization. The scope is then advanced further into the rectum towards the site of the volvulus, utilizing air insufflation to gently separate the mucosal folds for better visibility. During the examination, the mucosa is meticulously inspected for any signs of ischemia or necrosis, which could indicate compromised blood flow or tissue death. If the mucosa appears to be healthy, a rectal tube is then passed beyond the twisted segment of the intestine to relieve the obstruction by allowing gas and stool to be expelled. After the procedure, the scope is removed, and the rectal tube is secured in place at the perianal region, where it is typically left in position for a duration of 48 hours to ensure proper drainage and monitoring of the condition.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure of rigid proctosigmoidoscopy with decompression of volvulus is indicated for patients presenting with specific gastrointestinal symptoms and conditions. These indications include:
The procedure of rigid proctosigmoidoscopy with decompression of volvulus involves several critical steps to ensure effective diagnosis and treatment. The steps are as follows:
Following the rigid proctosigmoidoscopy with decompression of volvulus, patients are typically monitored for any immediate complications. The rectal tube, which is secured in place, is intended to remain for 48 hours to ensure proper drainage of gas and stool, thereby preventing re-obstruction. Patients may be advised to follow specific dietary guidelines and to report any unusual symptoms, such as increased pain, bleeding, or signs of infection. Follow-up appointments may be scheduled to assess recovery and to determine if further intervention is necessary.
| Short Descr | PROCTOSIGMOIDOSCOPY VOLVUL | Medium Descr | PROCTOSGMDSC RIGID DCMPRN VOLVULUS | Long Descr | Proctosigmoidoscopy, rigid; with decompression of volvulus | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 45300 Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P8C - Endoscopy - sigmoidoscopy | MUE | 1 | CCS Clinical Classification | 77 - Proctoscopy and anorectal biopsy |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2017-01-01 | Changed | Moderate (Conscious) Sedation flag removed. See new Moderate Sedation category. |
| Pre-1990 | Added | Code added. |
Get instant expert-level medical coding assistance.